Long-term outcome of hyperactive children

Diagnosis and Treatment of Attention Deficit Hyperactivity Disorder During Adolescence in the Primary Care Setting: A Concise Review

Attention deficit hyperactivity disorder (ADHD) is a chronic neurodevelopmental disorder with a worldwide prevalence of about 5% in school-age children. This review is intended to assist primary care providers (PCPs) in diagnosing and treating ADHD in adolescents. PubMed, PsychInfo, and Science Citation Index databases were searched from March 1990 to 2015 with the keywords: ADHD, primary care/pediatrics, and children/adolescents. Abstracts addressing diagnosis and/or treatment with 105 citations were identified including supplementary treatment guidelines/books. Adolescent ADHD presents with significant disturbances in attention, academic performance, and family relationships with unique issues associated with this developmental period. Diagnostic challenges include the variable symptom presentation during adolescence, complex differential diagnosis, and limited training and time for PCPs to conduct thorough evaluations. The evidence base for treatments in adolescence in comparison to those in children or adults with ADHD is relatively weak. Providers should be cognizant of prevention, early identification, and treatment of conditions associated with ADHD that emerge during adolescence such as substance use disorders. Adolescent ADHD management for the PCP is complex, requires further research, and perhaps new primary care psychiatric models, to assist in determining the optimal care for patients at this critical period.

Young adult educational and vocational outcomes of children diagnosed with ADHD

Decreased success at work and educational attainment by adulthood are of concern for children with ADHD given their widely documented academic difficulties; however there are few studies that have examined this empirically and even fewer that have studied predictors and individual variability of these outcomes. The current study compares young adults with and without a childhood diagnosis of ADHD on educational and occupational outcomes and the predictors of these outcomes. Participants were from the Pittsburgh ADHD Longitudinal Study (PALS), a prospective study with yearly data collection. Significant group differences were found for nearly all variables such that educational and occupational attainment was lower for adults with compared to adults without histories of childhood ADHD. Despite the mean difference, educational functioning was wide-ranging. High school academic achievement significantly predicted enrollment in post-high school education and academic and disciplinary problems mediated the relationship between childhood ADHD and post-high school education. Interestingly, ADHD diagnosis and disciplinary problems negatively predicted occupational status while enrollment in post-high school education was a positive predictor. Job loss was positively predicted by a higher rate of academic problems and diagnosis of ADHD. This study supports the need for interventions that target the child and adolescent predictors of later educational and occupational outcomes in addition to continuing treatment of ADHD in young adulthood targeting developmentally appropriate milestones, such as completing post-high school education and gaining and maintaining stable employment.

Social skills training for Attention Deficit Hyperactivity Disorder (ADHD) in children aged 5 to 18 years

BACKGROUND

Attention Deficit Hyperactivity Disorder (ADHD) in children is associated with hyperactivity and impulsitivity, attention problems, and difficulties with social interactions. Pharmacological treatment may alleviate symptoms of ADHD but seldom solves difficulties with social interactions. Social skills training may benefit ADHD children in their social interactions. We examined the effects of social skills training on children's social competences, general behaviour, ADHD symptoms, and performance in school.

OBJECTIVES

To assess the effects of social skills training in children and adolescents with ADHD.

SEARCH METHODS

We searched the following electronic databases: CENTRAL (2011, Issue1), MEDLINE (1948 to March 2011), EMBASE (1980 to March 2011), ERIC (1966 to March 2011 ), AMED (1985 to June 2011), PsycINFO (1806 to March 2011), CINAHL (1980 to March 2011), and Sociological Abstracts (1952 to March 2011). We also searched the metaRegister of Controlled Trials on 15 October 2010. We did not apply any language or date restrictions to the searches. We searched online conference abstracts and contacted 176 experts in the field for possible information about unpublished or ongoing RCTs.

SELECTION CRITERIA

Randomised trials investigating social skills training for children with ADHD as a stand alone treatment or as an adjunct to pharmacological treatment.

DATA COLLECTION AND ANALYSIS

We conducted the review according to the Cochrane Handbook for Systematic Reviews of Intervention. Two authors (OJS, MS) extracted data independently using an appropriate data collection form. We performed the analyses using Review Manager 5 software.

MAIN RESULTS

We included 11 randomised trials described in 26 records (all full text articles) in the review. The trials included a total of 747 participants. All participants were between five and 12 years of age. No trials assessed adolescents. In 10 of the trials the participants suffered from different comorbidities.The duration of the interventions ranged from eight to 10 weeks (eight trials) up to two years. The types of social skills interventions were named social skills training, cognitive behavioural intervention, multimodal behavioural/psychosocial therapy, behavioural therapy/treatment, behavioural and social skills treatment, and psychosocial treatment. The content of the social skills interventions were comparable and based on a cognitive behavioural model. Most of the trials compared child social skills training and parent training plus medication versus medication alone. Some of the experimental interventions also included teacher consultations.More than half of the trials were at high risk of bias regarding generation of the allocation sequence and allocation concealment. No trial reported blinding of participants and personnel and most of the trials had no reports regarding differences between groups in collateral medication for comorbid disorders. Overall, the trials had high risk of bias due to systematic errors. Even so, as recommended by the Cochrane Handbook of Systematic Reviews of Interventions, we used all eligible trials in the meta-analysis, but the results are downgraded to low quality evidence.There were no statistically significant treatment effects either on social skills competences (positive value = better for the intervention group) (SMD 0.16; 95% CI -0.04 to 0.36; 5 trials, n = 392), on the teacher-rated general behaviour (negative value = better for the intervention group) (SMD 0.00; 95% CI -0.21 to 0.21; 3 trials, n = 358), or on the ADHD symptoms (negative value = better for the intervention group) (SMD -0.02; 95% CI -0.19 to 0.16; 6 trials, n = 515).No serious or non-serious adverse events were reported.

AUTHORS' CONCLUSIONS

The review suggests that there is little evidence to support or refute social skills training for adolescents with ADHD. There is need for more trials, with low risk of bias and with a sufficient number of participants, investigating the efficacy of social skills training versus no training for both children and adolescents.

Update on attention deficit hyperactivity disorder

Attention deficit hyperactivity disorder (ADHD) is now the most frequent diagnosis in children seen by Australian general paediatricians. It is a heterogeneous neurodevelopmental disorder and is usually accompanied by one or more co-morbid developmental and/or mental health conditions. In addition to daily symptoms, which often impair quality of life, ADHD can compromise educational and social development for the individual, and impact on families, schools and the broader community. Draft revised National Health and Medical Research Council Guidelines on ADHD were published in November 2009. This comprehensive document discusses the evidence in relation to many aspects of ADHD, which inform the large number of practice recommendations. Although there is an enormous literature on the causes, neurobiology and management of ADHD, there is still much to be learned particularly in relation to early intervention, behavioural therapies and factors influencing long-term outcomes.

Randomised social-skills training and parental training plus standard treatment versus standard treatment of children with attention deficit hyperactivity disorder - the SOSTRA trial protocol

BACKGROUND

Children with attention deficit hyperactivity disorder (ADHD) are hyperactive and impulsive, cannot maintain attention, and have difficulties with social interactions. Medical treatment may alleviate symptoms of ADHD, but seldom solves difficulties with social interactions. Social-skills training may benefit ADHD children in their social interactions. We want to examine the effects of social-skills training on difficulties related to the children's ADHD symptoms and social interactions.

METHODS/DESIGN

The design is randomised two-armed, parallel group, assessor-blinded trial. Children aged 8-12 years with a diagnosis of ADHD are randomised to social-skills training and parental training plus standard treatment versus standard treatment alone. A sample size calculation estimated that at least 52 children must be included to show a 4-point difference in the primary outcome on the Conners 3rd Edition subscale for 'hyperactivity-impulsivity' between the intervention group and the control group. The outcomes will be assessed 3 and 6 months after randomisation. The primary outcome measure is ADHD symptoms. The secondary outcome is social skills. Tertiary outcomes include the relationship between social skills and symptoms of ADHD, the ability to form attachment, and parents' ADHD symptoms.

DISCUSSION

We hope that the results from this trial will show that the social-skills training together with medication may have a greater general effect on ADHD symptoms and social and emotional competencies than medication alone.

TRIAL REGISTRATION

ClinicalTrials (NCT): NCT00937469.

[The health economics of attention deficit hyperactivity disorder in Germany. Part 1: Health care utilization and cost of illness]

In the German region of Nordbaden, 5% of children (aged 7-12 years) and 1.3% of adolescents (aged 13-19 years) were diagnosed with attention deficit hyperactivity disorder (ADHD) in 2003. About two thirds of these patients were not seen by a physician specialized in psychiatry. Now the National Association of Statutory Health Insurance Physicians in Germany (Kassenaerztliche Bundesvereinigung, KBV) has developed a proposal for the integrated provision of care for these patients, combining a guidelines-oriented multidisciplinary approach with a system of quality assurance. Against this background, currently available ADHD-related data are presented, covering epidemiology, comorbidity and differential diagnosis, health care utilization, and cost of illness. According to administrative data analyses from Nordbaden, direct medical costs for patients with ADHD, from the perspective of statutory health insurance (SHI), exceed those of matched controls by a factor of >2.5. On this basis, ADHD-related expenditures of the German SHI may be estimated at around EUR 260 million in 2003, and almost certainly will have continued to grow further since. In addition to this, a diagnosis of ADHD is associated with substantial indirect cost. Although the literature on the burden of ADHD is incomplete, it seems plausible that the cost of illness might be comparable to that reported for alcohol and addiction disorders. Thus we anticipate an increasing relevance of formal health economic evaluations of health care programs offered to patients with ADHD.

Stimulant treatment in children with attention-deficit/hyperactivity disorder moderates adolescent academic outcome

Treatment with psychostimulant medication has been shown to improve scholastic functioning in children with attention-deficit/hyperactivity disorder (ADHD). However, the extent to which long-term academic gains are apparent in those having received such treatment remains elusive. This study examined prospectively the relationship of childhood stimulant treatment to academic functioning during adolescence. Children (n = 169) were initially recruited and diagnosed with ADHD when they were 7-11 years old. A subsample of those with childhood ADHD (n = 90) was reevaluated on average 9.13 (SD = 1.5) years later. Probands who did and did not receive treatment with stimulant medication were compared to each other and to a never-ADHD comparison group (n = 80) on three subtests from the Wechsler Individual Achievement Test-II (WIAT-II), as well as high school grade point average (GPA) and number of retentions in school as derived from school records. Analyses of covariance controlling for severity of childhood ADHD symptoms indicated that probands treated with psychostimulant medication achieved better academic outcomes, as measured by WIAT-II subtests and high school GPA, than those not treated with psychostimulants (p < .05). However, treated probands did not fare as well as the never-ADHD comparison group. Psychostimulant treatment for children with ADHD may benefit long-term adolescent academic performance, although the extent of improvement is likely to vary as a function of multiple factors.

Attention-deficit/hyperactivity disorder: a neuropsychological perspective towards DSM-V

Neuropsychological methods and techniques have much to offer in the evaluation of the individual suspected as having Attention-Deficit/Hyperactivity Disorder (ADHD). After a review of the historical evolution of the ADHD concept, incidence and prevalence, and DSM-IV criteria for diagnosis, especially as regards omission related to gender differences, and other associated cultural, familial, socioenvironmental, and subject influences, this paper describes a number of dilemmas and obstacles encountered in clinical practice. Included are the confounds associated with the wide range of possible comorbidities, the insufficiency of current DSM-IV criteria, the emergence of subtype differentiation and its impact on diagnosis and treatment. The complex relationship between neuropsychological constructs and ADHD, and obstacles to valid assessment are also addressed. The complexities associated with a thorough ADHD evaluation are viewed within an impressive and expansive existing scientific framework and recommendations are made for future directions.

Evidence-based guidelines for management of attention-deficit/hyperactivity disorder in adolescents in transition to adult services and in adults: recommendations from the British Association for Psychopharmacology

Attention-deficit/hyperactivity disorder (ADHD) is an established diagnosis in children, associated with a large body of evidence on the benefits of treatment. Adolescents with ADHD are now leaving children's services often with no readily identifiable adult service to support them, which presents problems as local pharmacy regulations often preclude the prescription of stimulant drugs by general practitioners (GPs). In addition, adults with ADHD symptoms are now starting to present to primary care and psychiatry services requesting assessment and treatment. For these reasons, the British Association for Psychopharmacology (BAP) thought it timely to hold a consensus conference to review the body of evidence on childhood ADHD and the growing literature on ADHD in older age groups. Much of this initial guidance on managing ADHD in adolescents in transition and in adults is based on expert opinion derived from childhood evidence. We hope that, by the time these guidelines are updated, much evidence will be available to address the many directions for future research that are detailed here.

Attention-deficit/hyperactivity disorder (ADHD) in the course of life

ADHD is a pervasive disorder that extensively impairs the quality of life and that can lead to serious secondary problems. Contrary to the prior assumption long-term studies have demonstrated that the disorder is not limited to childhood and adolescence. Unfortunately appropriate criteria for adults with ADHD are not given in the ICD-10. The clinical experience indicates substantial difficulties of adults, whose ADHS is not diagnosed and treated. They often cause extensive costs for the welfare system. The evidence-based psychiatric treatment is highly effective and inexpensive.

Attention-deficit/hyperactivity disorder: an overview of the etiology and a review of the literature relating to the correlates and lifecourse outcomes for men and women

This paper provides a summary of the current conceptualization of what AD/HD is, and its etiology, and then reviews some of the recent literature on the correlates and lifecourse outcomes for individuals diagnosed with Attention-Deficit/Hyperactivity Disorder (AD/HD). The intention is to synthesize that which is known, and to identify important gaps in the literature and knowledge base, which secondary analysis of prospective large-scale longitudinal cohorts, tracking individuals from birth to adulthood, could help to fill. This review highlights the fact that such datasets are rare and that their analysis offers important opportunities for advancing knowledge, particularly of the adult outcomes of childhood AD/HD.

The relation between attention deficit hyperactivity disorder and substance abuse: what role does conduct disorder play?

This paper presents a comprehensive review of the literature examining the relation between childhood attention deficit hyperactivity disorder (ADHD) and substance abuse. A number of researchers have statistically controlled for conduct disorder (CD) when examining the ADHD-substance-abuse relation. These studies have generally found that the ADHD-substance-abuse relation disappears when the high overlap between ADHD and CD is taken into account. On this basis, one may conclude that ADHD is unimportant to substance abuse. However, there is some evidence from both empirical studies and related fields that ADHD and CD may interact to afford a higher risk for substance abuse than may either disorder alone. Thus, ADHD appears to be important to substance abuse in that it interacts with CD to increase the risk. This paper calls for more research that directly examines the joint effects of ADHD and CD on risk for substance abuse. There is also a need for more research that examines gender differences, and mechanisms of the relations among ADHD, CD, and substance abuse.

Experienced emotion and affect recognition in adult attention-deficit hyperactivity disorder

Emotional competence and deficits that may disrupt interpersonal interactions were evaluated in 28 adults with attention-deficit hyperactivity disorder (ADHD) and 28 demographically equivalent controls. Participants completed tasks assessing affect recognition and experienced emotional intensity. Adults with ADHD performed worse in affect recognition than did adults without the disorder; however, the impairment was unrelated to gross perceptual processes, fundamental abilities in facial recognition, or attentional aspects of affect perception. Moreover, intensity of experienced emotion moderated affect recognition: Among controls, experienced emotion facilitated affect recognition. Among adults with ADHD, who reported significantly greater intensity, experienced emotion was inversely related to affect recognition. Results are consistent with theories of ADHD as a deficit in behavioral inhibition; yet, results may merely reflect a constellation of deficits associated with the disorder.

A study of self-perception in hyperactive children

PURPOSE

This research aimed to describe self-perception among hyperactive children in comparison with a general population of children of the same age.

DESIGN

A descriptive study with 116 children (between 6 and 11 years of age) distributed as follows: 57 hyperactive (20 girls and 37 boys) and 59 control group (25 girls and 34 boys). The hyperactive children were being treated at the outpatient clinic of a child psychiatry hospital. The children in the control group were recruited from a Quebec City elementary school.

METHODS

Children in both groups participated in an interview during which they answered the Self-Perception Profile for Children (r = 0.90) consisting of six well-defined subscales.

DATA ANALYSIS

Univariate analyses were used to describe the sociodemographic characteristics of both hyperactive and control group children. Groups were compared using t and chi-square tests. Univariate statistics were used to describe the characteristics of self-perception for each group overall and for each of the dimensions. Multivariate analysis was used to compare self-perception in hyperactive and control group children.

RESULTS

All dimensions of self-perception were lower among hyperactive children than among children in the control group, except athletic competence, which was higher. Multivariate analysis indicated that the dimensions of scholastic competence, social acceptance, and behavioral conduct were problem areas for hyperactive children.

CLINICAL IMPLICATIONS

Nursing care interventions for children with attention deficit hyperactivity disorder (ADHD) should be developed which assist children in increasing self-perception. This is a first step in developing a comprehensive plan of care.

The Adolescent Behavior Checklist: development and initial psychometric properties of a self-report measure for adolescents with ADHD

Developed and provided initial psychometric properties on an adolescent, self-report questionnaire for attention deficit hyperactivity disorder (ADHD). The Adolescent Behavior Checklist (ABC) consists of 44 items that measure ADHD core symptoms and associated difficulties (e.g., conduct problems, academic problems, and social deficits). A total of 909 adolescents between the ages of 11 and 17 served as the standardization sample. Results indicated that the ABC was internally consistent. Principal components analysis revealed six factors for the ABC: Conduct Problems, Impulsivity/Hyperactivity, Poor Work Habits, Inattention, Emotional Lability, and Social Problems. Significant gender and race differences were obtained for some ABC factor scores, and initial standardization data were established based on this information. Initial convergent and divergent validity of the ABC was supported by the correlations obtained between factor scores and the subscale scores on the Child Behavior Checklist and Youth Self-Report. Using an additional sample of 81 adolescents, the stability of ABC scores across a 2-week interval was found to be satisfactory. Initial evidence for discriminant validity was established by comparing ABC scores for a sample of adolescents diagnosed with ADHD to the normative sample.

MMPI characteristics in adults diagnosed with ADD: a preliminary report

Characterization of Attention Deficit Disorder (ADD) in adults has been hampered by an absence of well-defined clinical profiles on objective personality measures. A sample of 22 ADD adults completed personality testing (MMPI) in conjunction with cognitive assessment. A sample of 30 normal controls and 20 patients diagnosed with schizophrenia, who had completed the MMPI as part of a larger research protocol, were utilized as comparison groups. Validity and clinical scales revealed multiple elevations in the ADD group which were similar in nature but not to the same degree as elevations observed in the schizophrenia group. Harris-Lingoes subscales identified the sources of clinical scale elevations indicating a pattern of specific and nonspecific symptomatology which differentiated the three groups. The results may aid in identifying ADD in adults.

Neurobehavioural performance of adults with closed-head injury, adults with attention deficit, and controls

The symptoms experienced by people with mild closed-head injury (mCHI) and by people with attention deficit disorder (ADD) are similar in many aspects. We examined the performance of 26 adults with mCHI, 23 adults with ADD, and 25 matched controls on four functional areas: (1) simple motor response, (2) response speed and attention, (3) complex perceptual-motor performance, and (4) memory and learning. Analyses of variance and multivariate analyses of variance were used to compare the performance of the three groups. Test results were also plotted to examine patterns of performance and similarities between the groups. Both groups with mCHI and ADD had significantly more difficulty than controls with sustained attention. However, whereas the group with mCHI was characterized by generalized slowness in their response times, the group with ADD was characterized by impulsivity or an inability to regulate their attention and responses.

Correlates of family functioning when a child has attention deficit disorder

The purpose of this study was to examine the relationship among selected demographic and psychosocial family characteristics and family functioning and to identify which combination of variables best predicts family functioning when a child has attention deficit disorder. Seventy-six mothers and 47 fathers from 79 families participated in the study. The target child had been previously diagnosed with attention deficit disorder either with or without hyperactivity and aggressive symptoms. A significant correlation between family functioning and age of the hyperactive child was supported. Families of older children reported poorer functioning, and parenting competence was negatively related to parental perception of the child's behavior. Older age of the child in combination with higher levels of impulsivity/hyperactivity were significant in predicting family functioning.

Family functioning as perceived by parents of boys with attention deficit disorder

The purpose of this study was to describe adaptability, cohesion, and family type in families of boys with attention deficit disorder. Comparisons were made across diagnostic groups for boys with and without hyperactivity and aggressive symptoms. Parents (N = 123) of 79 boys with attention deficit disorder (ADD), attention deficit hyperactivity disorder and attention deficit hyperactivity disorder plus aggressive symptoms participated in the study. The families were not significantly different in their functioning when compared to family norms established by Olson, Portner, and Lavee (1985). There were, however, significant differences in functioning across diagnostic categories. Parents of boys with ADD only, without the additional problem of hyperactivity or aggressive symptoms, reported the highest level of family functioning, and a larger percentage of parents whose child had hyperactivity or hyperactivity plus aggression reported extreme family functioning.

Child demographics and DSM diagnosis: a multi-axis study

Using all five axes of the DSM-III, this study explored variations by gender, race age, and socioeconomic status in diagnoses given to children at an outpatient child guidance clinic. Overall, boys, minorities, and low income children were more likely to receive the more serious diagnoses on the DSM-III and to be given the diagnoses that are least likely to go into remission with the passage of time. Alternative explanations for these findings of differences are discussed, and implications for practice and research are identified.

Effects of two treatment techniques on delay and vigilance tasks with attention deficit hyperactive disorder (ADHD) children

In this study, we examined the effects of two treatment techniques under on-medication and off-medication conditions on the hyperactive behavior patterns of children. Three groups of subjects were compared: a control group, a behavior modification group, and a cognitive training group. The Gordon Diagnostic System (Gordon, McClure, & Post, 1986) was used to assess the subjects at the initial screening, during treatment without medication, and during treatment with medication. The two medication conditions were counterbalanced during the second and third testing sessions. Results showed that when the cognitive intervention was combined with medication, there was a significant improvement in the subjects' ability to delay impulsive responding. However, no significant effects were seen for sustained vigilance for either the behavioral or cognitive groups. Parents rated children in the cognitive group significantly higher than those in the control group.

Atypical outcome in attention deficit hyperactivity disorder

This report describes the course of psychiatric illness in two boys. Both presented with attention deficit hyperactivity disorder (ADHD) in midchildhood; after puberty, one boy developed a schizophrenic illness while the other boy developed a major affective illness. Although the major ADHD outcome studies have found no link between the childhood occurrence of ADHD and psychosis in adulthood, occasionally such a link may exist. The theoretical and practical implications of this finding are discussed. It should be noted, however, that such outcome is highly atypical and very rare.

Family factors associated with aggressive symptomatology in boys with attention deficit hyperactivity disorder: a research note

This study tested whether parent and child affective attitudes and interactional behavior co-varied with the presence or absence of associated aggressive symptomatology in families with an attention deficit hyperactivity disorder (ADHD) child. Affective attitudes of both parents and their ADHD sons were studied using a modified measure of expressed emotion, the five minute speech sample (FMSS-EE), in 29 families. A direct interaction task was also used to measure verbal and non-verbal communication. FMSS-EE status predicted parental interactional behavior, but the degree of child aggressiveness did not. The child's behavior towards parents, however, was highly correlated with their aggressiveness but not their EE status regarding their parents, despite the fact that child and parent EE were highly correlated. The study supports the notion that aggressiveness and a negative family climate may be independent factors in determining the long-term course of ADHD children.

Yale Children's Inventory (YCI): an instrument to assess children with attentional deficits and learning disabilities. I. Scale development and psychometric properties

The Yale Children's Inventory (YCI), a parent-based rating scale, and the scales derived from it have been developed to identify and measure multiple dimensions of learning disabilities with particular emphasis on attentional deficits. Scale construction was based on factor-analytic procedures. Measures of internal consistency, test-retest reliability, and coefficients of congruence support the reliability and stability of the 11 scales. A discriminant function classified normal and learning-disabled children with a relatively high rate of accuracy. The relationship and content of the three relevant YCI scales were compared to the DSM-III diagnostic categories for ADD. As operationalized, DSM-III criteria for hyperactivity formed a cohesive factor, while criteria for attention and impulsivity were not distinguishable from each other since they loaded together on a single factor. In contrast, the equivalent YCI scales for attention, impulsivity, and hyperactivity were found to be distinct.

Attention and impulsivity characteristics of the biological and adoptive parents of hyperactive and normal control children

On tests comparing 176 biological and adoptive parents of hyperactive and normal control children, biological parents of hyperactives evidenced more attentional difficulties, slower mean reaction times, and fewer correct recognitions than did the other parents. They showed no significant differences in impulsivity. A familial association between childhood hyperactivity and attentional deficits in the biological parents was suggested, as was the persistence of attentional difficulties as compared to impulse control problems.

Stimulant medications in adults with attention deficit disorder

The long-term prospective studies done in the last two decades on children suffering from attention deficit disorder with hyperactivity (ADD-H) give evidence of persistent disability in a majority of them when they reach adulthood. The literature on the use of stimulant medication in adults suffering from attention deficit disorder, residual type (ADD-R), is critically reviewed. After optimistic case reports two controlled double-blind studies have recently showed contradictory results. Some adults appear clearly to be helped by stimulant medication, but more investigations, especially with children diagnosed in childhood and followed-up, are needed before any firm conclusion can be made about the usefulness or non-usefulness of stimulants in ADD-R. There, as it is the case in childhood, medication might be insufficient by itself and might have to be associated with other forms of treatment.